Have you heard the one about the stent and the statin?
If you live long enough in a cholesterol-inducing place like Manhattan or the Bronx, you'll eventually need a dose of statins, too. Tweet
What’s the deal with this blood-pumping machine that seems to wear out after just a few decades of heavy use?
“I had a 95 percent blockage of the widow-maker artery.” “Just 95 percent? I had 100 percent!”
Heart disease can have a long silent phase before it gets seriously nasty — and we usually wait until we have symptoms.
On the coronary artery calcium test, there is only one passing grade — zero. “If you have any calcification, your 10-year risk goes up dramatically."
Invariably, when a group of men begin talking amongst themselves, the fact will eventually come up that one of them has a foreign object in his heart.
The guy will then tell you about his balloon-and-stent procedure. Then maybe another guy will chime in on having his chest split open so doctors could graft a vein from his leg onto his heart. And a third guy might just point to his chest and say, “Double bypass.”
In fact, those were numbers when I was at the dog park recently, and there were only four of us there. “I had a 95 percent blockage of the widow-maker artery.” “Just 95 percent? I had 100 percent!”
So the question arises: Is every human male doomed to have a stent or—heaven forbid—a bypass? What’s the deal with this blood-pumping machine that seems to wear out after just a few decades of heavy use?
So, if you’re at a party and there are twenty guys in attendance, chances are only eight will have had heart surgery or be taking medicine to prevent heart disease. Forty percent.
But wait: That’s just the number of those at that party who are going to die from it. There could be a dozen others in the same room who’ll die from something else—like getting hit by the ambulance taking someone else with heart disease to the hospital—who also have blocked arteries.
Heart disease is the number-one killer of men in the United States, nailing about a thousand of us every day.
Heart disease. The Centers for Disease Control and Prevention will tell you it is the number-one killer of men in the United States. In 2019, nearly 360,000 American men fell over dead from coronary artery disease, the thing that causes fatal heart attacks and some strokes. And it’s not just old guys, either. About a quarter of heart disease-related deaths take out men ages 35 to 65.
Sound bad? It could be worse—and it used to be. The death rate from heart disease “has actually gone down a lot from the mid-‘80s,” notes cardiologist John A. Osborne, “because we got people to quit smoking. We started [patients] on statins, we got control of blood pressure, those sort of things.”
Osborne, National Director of Cardiology for the LowT Centers/HerKare Centers near Dallas, is all about preventive treatment — i.e., the stuff you do to keep you from going under the knife—aka, the things we usually don’t take seriously until it’s too late. He notes that in comparison to cancer, “where we have a very firmly established understanding and everybody gets early screenings,” with heart disease, which can have “a 20-, 30-, 40-year-long silent phase” before it gets seriously nasty, we generally wait until we have symptoms. “But by then you already need mechanical fixes.”
In 2018, the American College of Cardiology unveiled cholesterol guidelines that for the first time designated a screening strategy. If your idea of a heart disease screening is being hooked up to a treadmill for a robust run while a physician’s assistant watches you sweat, forget it. These days they can test how supple your heart arteries are to see what your risk factor might be.
“It’s a coronary artery calcium score, or CAC,” notes Osborne. “You’ve heard the term ‘hardening of the arteries’—that is true. When plaque builds up, literally there is calcification hardening building up in the blood vessels of the heart. And that occurs long before we ever have symptoms.”
With a CAC, there’s no fasting, no injections, no treadmill. This test involves a computerized tomography scanner—that’s ‘CAT scan’ to you—and your heart. It usually costs about a hundred bucks. You can do it lying down. Or playing dead.
The examining doctor looks for calcifications, tell-tale signs that action is required. There is only one passing grade for this test: Zero. “If you’re zero, which is the only normal score, your 10-year risk is extremely low,” says Osborne. “If you have any calcification, your 10-year risk goes up quite dramatically.”
At that point, you are likely to be prescribed a daily low-dose “baby” aspirin to thin your blood or a statin to lower your “bad” cholesterol level, or if it’s bad enough, both. And, by the way, for all their association with the heart, statins actually operate on a different organ, the liver, which in addition to cleaning your innards, also makes cholesterol.
Like all powerful medications, statins come with risks. The Mayo Clinic acknowledges they have been linked to muscle pain, digestive problems, and high blood sugar levels (which can lead to type 2 diabetes), not to mention the rare case of liver damage.
There’s also the possibility of “brain fog”—dizziness, memory loss, a general inability to think clearly. (Check out the web for innumerable unhappy first-person reports.) Most are likely the result of overdosing, and happily, the effects are reversible. Bottom line: If you think you are having a side effect from the statin, you might be right, so talk to your doctor.
In case you’re wondering: Yes, obviously, lots of women contract and die from heart disease, just not nearly as many as men. According to the CDC, about 20 percent of women will die from it, which is bad enough. Still, you won’t find women huddled in a corner at parties, talking heart disease. Lucky for them, women on statin island have far less company.